Prevalence of Urinary Tract Infection, Bacteremia, and Meningitis Among Febrile Infants Aged 8 to 60 Days With SARS-CoV-2
Authors: Paul L. Aronson, Jeffrey P. Louie, Ellen Kerns, Brittany Jennings, Sloane Magee, Marie E. Wang, Nisha Gupta, Christopher Kovaleski, Lauren M. McDaniel, Corrie E. McDaniel, Chisom Agbim, Owen Amadasun, Nicholas Beam, Bradley D. Beamon, Heather J. Becker, Emma M. Bedard, Eric Biondi, Jenna Boulet, Amelia Bray-Aschenbrenner, Rona Brooks, Clifford Chen, Jacqueline B. Corboy, Nickolas Dawlabani, Guillermo De Angulo, Senayit Demie, Jennifer Drexler, Nanette Dudley, Andrew Ellis, Kelsey Fath, Alejandra Frauenfelder, Jeff Gill, Thomas Graf, Melissa Grageda, Heidi Greening, Alison M Griffin, Amy Groen, David T. Guernsey III, Sarah Gustafson, W Caleb Hancock, Sujit Iyer, Patti Jo Jaiyeola, Aditi Jayanth, Rebecca M. Jennings, Svetlana S. Kachan-Liu, Aditi Kamat, Isaac J. Kennedy, Loay Khateeb, Ohmed Khilji, Elizabeth A. Kleweno, Anika Kumar, Stephanie Kwon, Alicia La, Petra Laeven-Sessions, Kaitlyn Phuong Le, Rianna C. Leazer, Kelly A. Levasseur, Emilee C. Lewis, Walid M. Maalouli, Bonnie S. Mackenzie, Kathleen E. Mahoney, Deborah M. Margulis, Lauren Maskin, Emily McCarty, Alexa N. Monroy, John M. Morrison, Jennifer H. Myszewski, Nicole L. Nadeau, Suresh Nagappan, Kristen Newcomer, Matthew C. Nordstrom, Diana Nguyen, Peter O'Day, Yuliya Oumarbaeva-Malone, Ursula Parlin, Summer Peters, Mary Jane Piroutek, Renee Quarrie, Kerrilynn Rice, Teresa M. Romano, Sahar N. Rooholamini, Cynthia L. Schroeder, Elizabeth K. Segar, Patrick Seitzinger, Suparna Sharma, Blair E. Simpson, Prachi Singh, Yasmine Sobeih, Sakina Sojar, Karthik Srinivasan, Emily C. Sterrett, Mary Elizabeth Swift-Taylor, Sara Szkola, Jennifer Thull-Freedman, Irina Topoz, Tatyana Vayngortin, Christopher Veit, Yenimar Ventura-Polanco, Ashley Wallace Wu, Lindsay Weiss, Erika K. Wong, Sara Zafar
Journal: JAMA Network Open (2023)

The prevalence of urinary tract infection (UTI), bacteremia, and bacterial meningitis in febrile infants with SARS-CoV-2 is largely unknown. Knowledge of the prevalence of these bacterial infections among febrile infants with SARS-CoV-2 can inform clinical decision-making. To describe the prevalence of UTI, bacteremia, and bacterial meningitis among febrile infants aged 8 to 60 days with SARS-CoV-2 vs without SARS-CoV-2. This multicenter cross-sectional study was conducted as part of a quality improvement initiative at 106 hospitals in the US and Canada. Participants included full-term, previously healthy, well-appearing infants aged 8 to 60 days without bronchiolitis and with a temperature of at least 38 °C who underwent SARS-CoV-2 testing in the emergency department or hospital between November 1, 2020, and October 31, 2022. Statistical analysis was performed from September 2022 to March 2023. SARS-CoV-2 positivity and, for SARS-CoV-2-positive infants, the presence of normal vs abnormal inflammatory marker (IM) levels. Outcomes were ascertained by medical record review and included the prevalence of UTI, bacteremia without meningitis, and bacterial meningitis. The proportion of infants who were SARS-CoV-2 positive vs negative was calculated for each infection type, and stratified by age group and normal vs abnormal IMs. Among 14 402 febrile infants with SARS-CoV-2 testing, 8413 (58.4%) were aged 29 to 60 days; 8143 (56.5%) were male; and 3753 (26.1%) tested positive. Compared with infants who tested negative, a lower proportion of infants who tested positive for SARS-CoV-2 had UTI (0.8% [95% CI, 0.5%-1.1%]) vs 7.6% [95% CI, 7.1%-8.1%]), bacteremia without meningitis (0.2% [95% CI, 0.1%-0.3%] vs 2.1% [95% CI, 1.8%-2.4%]), and bacterial meningitis (<0.1% [95% CI, 0%-0.2%] vs 0.5% [95% CI, 0.4%-0.6%]). Among infants aged 29 to 60 days who tested positive for SARS-CoV-2, 0.4% (95% CI, 0.2%-0.7%) had UTI, less than 0.1% (95% CI, 0%-0.2%) had bacteremia, and less than 0.1% (95% CI, 0%-0.1%) had meningitis. Among SARS-CoV-2-positive infants, a lower proportion of those with normal IMs had bacteremia and/or bacterial meningitis compared with those with abnormal IMs (<0.1% [0%-0.2%] vs 1.8% [0.6%-3.1%]). The prevalence of UTI, bacteremia, and bacterial meningitis was lower for febrile infants who tested positive for SARS-CoV-2, particularly infants aged 29 to 60 days and those with normal IMs. These findings may help inform management of certain febrile infants who test positive for SARS-CoV-2.